Orphanages - The Myths and Reality of Institutional Care



The Myths and Reality of Institutional Care
reprinted with permission from Children's Rights, by AFTER.

There recently has been a resurgence of interest in the use of orphanages - now known as "academies, "villages," and "residential charter schools," and by other designations - for the full-time care of children in foster care. The call for orphanages harkens back to child care patterns of the mid-to-late 19th century when orphanages were used to house children who were orphaned or abandoned or whose parents were temporarily unable to care for them because of illness or poverty. At the time, few other options were available for dependent children. By 1900, however, concerns about the use of orphanages had begun to grow and alternative ways of caring for children - direct supports and services for their families, boarding out (the forerunner of foster care), and adoption - had begun to be championed over the institutional care of children. As the negative developmental, psychological and social effects of orphanages on children became better understood, these alternatives became the focus of various social and legislative reforms. Within a few decades, orphanages across the country closed or were redesigned to provide different types of services for children.

The recurrent calls over the past decade for a return to orphanages generally involve claims that long-term institutional care is, in reality, very good for children-in fact, better than (or, at least, a reasonable alternative to) the alternatives that have formed the basis for children's care in the United States for close to 75 years. The claims made on behalf of orphanages are often buttressed with nostalgic presentations of children's genteel and joyful lives in institutions - as perhaps best embodied in the idyllic depiction of the St. Clouds Orphanage and the kindly Dr. Larch in The Cider House Rules. But The Cider House Rules is, literally, the Disney version.

The realities of orphanages are far different from the myths that have tended to shape the public debate about a return to institutional care for children. Research and direct practice have demonstrated time and again that orphanages are not good for children. In fact, as became evident almost a century ago, they are affirmatively harmful. Unlike today's residential group treatment programs (which emphasize short-term treatment, children's connections with their families, aftercare services, and permanency either through the child's return home or through adoption), these facilities are based on an assumption that they are a bona fide substitute for children's families.

There are five common myths about the "benefits" of orphanages- all of which present an inaccurate and misleading picture of the impact of institutional care on children and youth.

Myth #1:

Orphanages are better for children than care by foster families.

Myth #2:

Orphanages are safer and more stable than family foster care.

Myth #3:

Orphanages provide the same connections between children and their birth families as foster families provide.

Myth #4:

Orphanages are less expensive than family foster care.

Myth #5:

Orphanages are needed because there simply are not enough foster parents.

Myth #6:

Orphanages are better for children than care by foster families.

This myth takes a variety of forms:

Because orphanages meet the needs, of children for structure, discipline and values, and all the services that children need are in one place 24-hours a day, children do much better in orphanages than they do with foster families.

Reality: Study after study (as documented by Dr. Deborah Frank and her colleagues [1996]) has demonstrated that young children in institutional care are extremely vulnerable to medical and psychological problems. In the short term, orphanages put young children at increased risk of delayed language development, other developmental problems, and infectious illnesses. In the long term, institutionalization in early childhood increases the likelihood that children will grow into psychologically impaired and economically unproductive adults. Children reared in institutions (compared to children reised by families) have been found to have lower IQ scores; difficulties forming and maintaining relationships with others; and poor self-esteem.

Even youth placed in institutions as teenagere fare more poorly than youth whose care is provided by foster families. Triseliotis (1983), among other researchers, found that institutionalized youth have greater social impairment, exhibit more coercive interactions with adults, and consider themselves (when compared to youth in foster family care) less loved, less looked after, less trusted, and less wanted. Orphanages meet the needs of seriously disturbed children. Many children have such serious emotional and behavioral problems that they cannot live in a family environment. The only real alternative for them is to be placed in an orphanage where they can be closely supervised around the clock.

Reality: Research not only fails to show that children with serious emotional problems benefit from orphanage settings -- they show that children's emotional and behavioral status worsens. Tizard and Rees (1975) and others have found that even in small, well-run institutional settings, children develop a range of negative behaviors, including aggression and indiscriminate affection toward adults. On the other hand, alternatives to residential care for children with serious emotional problems - day treatment programs (in which children and youth receive intensive treatment services in a non-residential environment) and specialized family foster care (in which children live with foster parents who are specially trained and supported to work with children who have serious emotional or behavioral problems) - have been found to achieve extremely positive results for children for whom residential care previously was considered the only alternative (see Schutjer, 1982; Chamberlain & Weinrott, 1990).

The care is better in orphanages because the staff are professionals -they are well-trained, supervised, and monitored.

Reality: Fuhrmann and Munchel (1995) found a number of problems related to the staffing of institutional settings -- including limited training, lack of appropriate supervision, few opportunities for professional advancement, and the need for staff to better understand the needs of children and appropriate discipline techniques. Most child care staff do not have professional backgrounds, and unlike foster parents, they are not subject to rigorous screening prior to providing care for children.

Orphanages make it possible to keep siblings together.

Reality: Nearly all states allow exceptions to licensing rules regarding the number of children who may be placed in with a family when siblings enter foster care together. Consequently, sibling groups routinely are placed with relatives and with non-relative foster parents. At the same time, orphanages do not guarantee that siblings will live in close proximity. Siblings of different ages who enter institutions may well be placed in different units of the facility.

Unlike adults who were raised in family foster care, adults raised in orphanages go on to live productive, happy lives.

Reality: Care in orphanage settings consistently been shown to have long-term psychological and social effects on children into adulthood. Studies by Quinton, Ruttter and Liddie (1984) and others have demonstrated that individuals placed in orphanages early in their lives are at greater risk when they reach adulthood of living in poverty, developing psychiatric disorders, having difficulties in interpersonal relationships, and having serious problems parenting their own children. The lack of opportunities for close, consistent, and caring relationships with adults in institutional settings has a significant impact on children into adulthood.

Myth #2:

Orphanages are safer and more stable than family foster care.

Orphanages are safer than other out-of-home settings for children.

Reality: To the contrary, data reveal that rates of abuse are as high or higher in residential settings than in family foster care (see Myers, O'Neil, & Jones, 1999; Hobbs, Hobbs, & VVynne, 1999). Several factors contribute to abuse of children in institutions -- inadequate monitoring and inspections, staff feelings of powerlessness, policies that condone the control and restraint of children, lack of clarity of mission, and autocratic management.

Orphanages provide more stable living arrangements.

Reality: There is no evidence that children in orphanages experience a greater sense of stability than do children in family foster care. Tizard and Hodges (1978) found that a child in an orphanage has, on average, 10 caregivers a day -- owing to staff shift changes throughout the day. At the same time, the caregivers themselves frequently change as a result of high staff turnover -- with serious implications for children's growth and development.

Myth #3:

Orphanages provide the same connections between children and their birth families as foster families provide.

Reality: Unlike family foster care, orphanages do not place emphasis on children's connections with their parents and members of their extended families. They do not work to reunite children with their birth families or find other families for children through adoption. Orphanages, in fact, see themselves as substitutes for children's birth families. That "family" role, however, lasts only until children are discharged from the facility-- at which time, they are left to fend for themselves with no family to support them as they attempt to transition into adulthood and independence.

Myth #.4:

Orphanages are less expensive than family foster care.

Reality: Orphanages are actually far more expensive that family foster care -- costing between 3 and 7 times the cost of caring for a child in a family environment (North American Council on Adoptable Children, 2001).

Myth #5:

Orphanages are needed because there simply are not enough foster parents.

Reality: In some states, such as Minnesota, there are ample numbers of foster families to care for children. In other communities, the recruitment of foster families to provide care for the growing number of children in foster care has continued to pose a key challenge. As organizations such as the Casey Family Programs National Center for Resource Family Support (2002) have documented, however, success in retaining current foster families and recruiting new families is greatly facilitated by investments in services and supports (such as adequate subsidies, quality training, and respite care) that make it possible for foster families to provide the care that children need. The demand for foster parents also may be reduced - by investing resources in programs that have been shown to safely and effectively keep children with their birth parents. No matter how attractive they may seem, institutions cannot meet the developmental needs of children and youth. Rather than diverting precious resources into the construction, maintenance, and staffing of such facilities, investments must be made in helping birth families stay together and in supports and services that attract and sustain caring foster families for children who cannot remain with their birth families.


Casey Family Programs National Center for Resource Family Support. (2002). Resource Family Support and Retention. Available: http://www.casey.org/cnc/support-retention/index, htm (Viewed February 12, 2002).

Chamberlain, P. & Weinrott, M. (1990). Specialized foster care: Treating seriously emotionally disturbed children. Children Today, January/February, 24-27.

Frank, D., Klass, P., Earls, F., & Eisenberg, L. (1996). Infants and young children in orphanages: One view from pediatrics and child psychiatry. Pediatncs, 97(4), 569-578.

Fuhrmann, B. S. & Munchel, R. L. (1995). Residential Care in a Rapidly Changing Environment. Caring, 11 (3), 31-35.

Hobbs, G.F., Hobbs, C.J., & VVynne, J.M. (1999). Abuse of children in foster and residential care. Child Abuse and Neglect, 23(7), 1239-1252.

Myers, J., O'Neill, T. & Jones, J. Preventing institutional abuse: An exploration of children's rights, needs and participation in residential care. In Children Abuse and Child Protection (pp. 193-210). New York, NY: John Wiley and Sons, Inc.

North American Council on Adoptable Children. (2001). Research Findings on Institutional Care. St. Paul, MN: NACAC.

Schutjer, M. (1982). Day treatment for delinquent youth: An alternative to residential care. Children Today, January/February, 20-24.

Tizard, B. & Hodges, J. (1978). The effect of early institutional rearing on the development of eight-year-old children. The Joumal of Child Psychology and Psychiatry, 19, 99-118.

Tizard, B. & Rees, J. (1975). The effect of early institutional rearing on the behavior problems and affectional relationships of four-year-old children. The Journal of Child Psychology and Psychiatry, 16, 61-73.

Triseliotis, J. (1983). Identity and Security in Adoption and Long-Term Fostering. Adoption and Fostering, 7(1), 22-31.


Small instiutions or big family?

Reading a blog of a woman who had 31 foster children under her roof, one question arose: what is the difference between an amateur run institution and  foster care family? I wouldn't call a group of 31 children a family. And this woman is not the only one having many many children in her house, there are many many examples of really big groups of children living with a couple or a single person. That way, of course the state funding makes this defacto a paid job, but  apart from a foster care licence there need not be more credentials to run what in my eyes looks like a home grown facility.

That in and of itself is not necessarily detrimental to a child, what is though, is limiting the options to either foster-care or institutionalized care. Different children need different solutions. It's almost the same as the debate over family reunion, versus placement. There is no one size fits all. Some children have such a horrible life in their natural family, it would be betrayal to them to push reunion, while other children will forever keep their mouth, because the consequence of placement was harder than the consequence of living at home. For some children a group home is the best way to go, because their mistrust of family style living is too big, other's need institutionalized care, because otherwise they are a danger too themselves, yet other children fare well in foster-care.

Instead of having a debate over what form is the under all circumstances the best, let's look at the pros and cons of each solution and choose the best or and that's probably more realistic, the least worse.

Pound Pup Legacy